Profile of Danish women undergoing reversal of sterilization, 1978-1983

To help identify those women who might regret undergoing sterilization, the Danish women refertilized from 1978 to 1983 were contacted by mailed questionnaire. Eighty-three percent (120/144) responded. These women were younger at the time of sterilization than Danish women sterilized in the same period (mean age 29 years versus 34 years). Furthermore, they had more children at the time of sterilization and had their first and last child at a younger age than Danish women generally, in the same age group. Their social and educational status was lower than the background population and fewer were in gainful employment. At sterilization, most of the women were in an emotionally stressful situation (e.g., marital disharmony (78% of the married women), single parenthood (28%), unwanted pregnancy (27%], or had chronic health problems in the family. Alternative contraceptive methods had not been fully explored. Thirty-eight percent complained of late secondary effects attributable to the sterilization, but the main reason for wanting reversal of sterilization was a new partner (75%). The study suggests that the psycho-social situation and contraceptive alternatives should be carefully evaluated in women requesting sterilization, especially in those below the age of 30.     

Characteristics of women requesting reversal of sterilization

For a definition of the characteristics of women who request reversal of sterilization, 180 such women were compared with 180 women apparently satisfied with sterilization. Women who requested tubal reversal were younger at the time of sterilization, began and completed their families at an earlier age, and were of lower socioeconomic status than those who did not request reversal of sterilization. Women requesting reversal of sterilization had a significantly higher incidence of gynecologic clinic visits after and mental health clinic visits before and after sterilization. Thirty-five women requesting reversal of sterilization were compared with 35 control women by administration of the Minnesota Multiphasic Personality Inventory (MMPI). Higher MMPI scores on the hysteria and psychasthenia scales were noted in women requesting tubal reversal.     

Peritoneal endometriosis in women requesting reversal of sterilization

Seventy-six women requesting reversal of sterilization underwent at least 1 operative procedure during a 27-month period, and 14 (18.4%) were found to have pelvic endometriosis. The endometriosis patients were noted to have had significantly fewer pregnancies (1.8 versus 2.9, P less than 0.01) before sterilization than those without endometriosis, but the two groups did not differ significantly in mean age (30.8 versus 30.3 years), type of sterilization or in mean number of years since sterilization (5.0 versus 5.5 years). In only two individuals were proximal tubal segment fistulas found at the time of reversal, and neither had endometriosis. We conclude that pelvic endometriosis is more common in patients with bilateral tubal occlusion than previously suspected and that its presence indicates that endometriosis implants can persist for prolonged periods of time, can give rise to new implants, or do not require the tubal reflux of menstrual debris to form.     

Profile of women requesting reversal of sterilization

One hundred consecutive patients requesting reversal of sterilization have been analyzed. At the time of sterilization 52% were 25 years old or under and 89% were 30 years old or under. Fifty-three patients were not in a stable marital relationship. The mean number of children per patient was 2.39. Two-thirds of the 47 patients who underwent pueperal sterilization regretted their decision within the 1st year. Twenty-six percent of the patients felt psychologically adversely affected by the procedure. The reason for requesting reversal of sterilization in the majority (63%) was a change in marital status. Other reasons were crib death (17%), desire for more children (10%), psychologic factors (6%) accidental tragedies (4%).     

The fate of women requesting reversal of tubal sterilization

Although it was not possible to identify by simple demographic measurements those women who would elect not to pursue full investigation, this study has highlighted the high drop-out rate of women requesting reversal, and suggested that discussion with the couple at the first visit is a valid procedure, particularly if it allows as many as one-third of patients to elect not to proceed to invasive procedures. Finally, this study underscores that when gynecologists are counseling patients with respect to sterilization and the question of reversibility is opened, the success rate is not in excess of 50% when it is considered a function of the number of women regretting reversal rather than a function of women who undergo surgery.     

Caesarean section dissected, 1978-1983

Of 32735 singleton births in Oxford in the 6 years 1978-1983, 10% were by caesarean section. In contrast to the national data, no trend in this rate was observed. Repeat caesarean sections accounted for 30% of all sections and the proportion of women who had had a previous caesarean section rose gradually in the hospital population. The other main indications for section were dystocia, fetal distress in labour and breech presentation, which together accounted for a further 45% of all sections. Comparison with caesarean section rates reported from North America shows that repeat sections and sections for dystocia were less frequent in Oxford but the rates for other indications were similar. Dystocia is likely to be a key factor in determining future section rates. Dystocia occurred mainly in primiparae, and was more common with short stature and with increasing gestation and maternal age. For all height, age and gestation groups dystocia was more than twice as frequent in induced as in non-induced labour. This association does not imply a causal relationship, but neither is one excluded.     

Tubal anastomosis for reversal of sterilization with microsurgical technic in 246 women

Tubal anastomosis for reversal of sterilization was performed with microsurgical technique in 246 women, from January 1985 to June 1987. The operation time after tubal sterilization averaged 43.5 months. The patients (99.6%) were followed-up for 3-33 months. Intrauterine pregnancies occurred in 178 cases, the rate being 72.4%. The factors which influence success rate are the tubal length after anastomosis and the mode of original tubal ligation. Postoperative instillation of fluids into fallopian tubes should be performed early to prevent adhesions and early intercourse should also be encouraged.     

Sterilization failure,sterilization reversal,and pregnancy after sterilization reversal in Quebec

OBJECTIVE: 1). To determine the likelihood of sterilization reversal and of subsequent sterilization after sterilization reversal among men and women and 2). to examine the likelihood of pregnancy after sterilization (contraceptive failure) and of pregnancy after sterilization reversal. METHODS: Payment data from the Quebec provincial health insurance system were obtained for each person undergoing vasectomy or female sterilization from January 1, 1980 to December 31, 1999 and linked through a unique identifying number for each person. Using standard techniques of survival analysis, we computed the cumulative probability of experiencing each of six events. RESULTS: Among women, 0.9% (of 311960) experienced a pregnancy after sterilization, 1.8% (of 321929) obtained a reversal after sterilization, 61% (of 4369) achieved a pregnancy after sterilization reversal and 48% achieved a delivery; 23% (of 4677) obtained a subsequent sterilization after reversal. Among men, 2.4% (of 310827) obtained a reversal after vasectomy and 18% (of 6694) obtained a subsequent vasectomy after reversal. All of these risks were much higher among those in the youngest age groups. CONCLUSION: Sterilization reversal and pregnancy after sterilization are not rare. Relatively high rates of reversal among the youngest age groups suggest a need for better counseling about alternative contraceptive strategies.     

Microsurgical reversal of female sterilization

Between 1979 and 1985, 25 consecutive, unselected women (age 28-40 years, median 34) underwent microsurgical tubo-tubal anastomosis for reversal of sterilization. The overall pregnancy rate was 44%. The incidence of pregnancy was correlated to the tubal length after reversal. Of 12 women with tubal lengths exceeding 5.5 cm, 8 (67%) became pregnant. Of the 13 women with tubal lengths under 5.5 cm only 3 (23%) conceived (p less than 0.04). There was no significant correlation between pregnancy rate and age, interval since sterilization, or the sterilization procedure itself.     

Fertility outcome after reversal of sterilization

OBJECTIVE: The study was designed to evaluate the fertility outcome in sterilization reversals and a variety of factors that have been suggested to influence the successful outcome of sterilization reversal procedures. METHOD: It is a retrospective study involving all sterilization reversals performed between January 1991 and December 1995 in our hospital. A total of 58 cases were treated. Tubal anastomosis was performed according to rules of microsurgery. The loupe microsurgical technique with 4 x magnification comprising two main phases, preparation of healthy tubal segments and anastomosis carried out in two layers. RESULTS: It was possible to study subsequent fertility of 50 patients in all, as 8 patients were lost to follow-up (13.76%). The overall conception rate was 68% (34 cases), out of which intrauterine pregnancy rate was 62% (31 cases), ectopic pregnancy rate was 6% and the abortion rate was 6%. Fifty percent of patients conceived within first 12 months of reversal of sterilization. The isthmic-isthmic type of anastomosis has maximum incidence of pregnancies (88.88%). CONCLUSION: Laparoscopic (Falope ring) sterilization should be preferred in women who are willing for interval sterilization and it should be done at isthmic segment of the tube, whereas the Pomeroy's method is to be reserved for occasional postpartum procedure. Reversal of sterilization should be done with strict adherence to principles of microsurgery.     

Preliminary counseling with age-related fertility rates does not influence whether women undergo reversal of sterilization

Our objective was to assess the influence of preliminary counseling that provided information about age-related fertility rates on the decision of women to undergo reversal of sterilization. There was no apparent influence; this raises the question as to whether couples seeking fertility therapy base their decision making on factual information provided by the clinician.     

Characteristics of patients requesting reversal of sterilization

With the increased number of female patients seeking sterilization and the good chance of successful reversal using modern microsurgical techniques, it can be anticipated there will be a rise in the number of patients requesting reversal of sterilization. We have studied the characteristics of 36 patients who requested reversal of sterilization at the Royal Infirmary, Edinburgh, in the last five years. The majority of patients requested reversal on the basis of a new relationship. Other reasons included sexual problems and child death. Eighteen of the patients had clear evidence of marital disharmony at the time of sterilization. Seven of the patients had been admitted to hospital with a drug overdose since being sterilized.     

Luteal deficiency among women with normal menstrual cycles, requesting reversal of tubal sterilization.

Forty women with normal menstrual cycles who had been sterilized by tubal ligation or electrocoagulation requested tubal reconstruction. As part of their preoperative evaluation, progesterone measurements were obtained in the midluteal phase (5-10 days before the next menstrual period). This group of women had a significantly lower (P less than 0.005) mean midluteal progesterone level (9.4 +/- 4.7 ng/ml) than a control group of 24 women with infertile male partners attending the same clinic (17.4 +/- 7.1 ng/ml). In 25 (62%) of the sterilized women, progesterone levels were less than 10 ng/ml, whereas in the control group such low values were found in only 4 (17%) of the women. Thus, reduced midluteal serum progesterone concentration appears more common among women with prior tubal ligation or electrocoagulation than among a control population of apparently normal women.     

Contraception and voluntary sterilization: male sterilization and the possibility of reversal

Vasectomy is a simple and safe procedure, regularly done on an outpatient basis. Since spontaneous recanalization of the vasa deferentia is always possible, researchers have experimented with other means of surgical obstruction of the vasa; such experiments, which involved silastic plugs, intravasal threads, tantalium clips, and hard or soft valves, have not been very successful. Together with an increased demand for vasectomy goes an increased demand for vasectomy reversal. Vas reanastomosis is an extremely difficult and lengthy surgical procedure; failure is usually due to anatomical and/or functional causes related and consequent to the previous vasectomy. If reversibility is surgically successful in 60% of cases, the functional success of the procedure is only about 40%. Hence the importance of sound judgment, maturity and objective counseling prior to sterilization.     

Tubotubal anastomosis for reversal of female sterilization in Thailand

From September 1979 to December 1983, 168 women requested sterilization reversal. Forty-four of them were selected for tubotubal anastomosis, employing a microsurgical technique. The mean age was 28.7 years (range, 22-37), the mean number of pregnancies was 2.0 (range, 0-3), and the mean number of living children was 1.6 (range, 0-3). The main reason for the reversal request was remarriage (63.63%). The overall crude rate of full-term intrauterine pregnancies resulting in live births was 61.4%. The ectopic pregnancy rate was 4.5% and the abortion rate, 2.3%. Three cases were lost to follow-up. Life-table analysis revealed a cumulative pregnancy rate of 77% one year after surgery and 80% two years after surgery.     

Microsurgical reversal of sterilization: a six-year study

A prospective study of 113 personal consecutive microsurgical reversals of female sterilization during the 6-year period from 1979 to 1984 was carried out to determine factors affecting the pregnancy rate. The sterilizations were performed by laparoscopic unipolar coagulation in 54% of the patients, by the Pomeroy technique in 28%, by fimbriectomy in 8%, by the Irving operation in 5%, and by clips or rings in 4%. In the group with no minimum follow-up period, 50% had intrauterine pregnancies and 5% had ectopic gestations. Eighty-nine patients had at least 12 months of follow-up after reversal surgery. This group is studied in detail. Factors affecting the pregnancy rate were length of tube, type of sterilization performed, anastomotic site, and availability of both tubes for reconstruction. Age, parity, and interval from sterilization to reversal surgery did not affect the pregnancy rate. Fifty percent of the intrauterine pregnancies were conceived within 6 months of reversal surgery.     

The role of Essure sterilization performed simultaneously with endometrial ablation

PURPOSE OF REVIEW: To review operative procedures, specific risks, complications and evaluation of efficacy of Essure tubal sterilization performed simultaneously with endometrial ablation. RECENT FINDINGS: Dysfunctional uterine bleeding is a significant health problem in premenopausal women. Endometrial ablation is an effective therapeutic option for the management of menorrhagia and an alternative to hysterectomy. Most women undergoing endometrial ablation are of reproductive age, and, because pregnancy after endometrial ablation could be complicated, many of these women require permanent birth control. Since the introduction of Essure tubal sterilization, this permanent contraception method has been widely used and offers an hysteroscopic approach similar to endometrial ablation techniques. Combining these two procedures offers the advantage of performing the two procedures simultaneously, but inherent rules and technical procedures must be followed to avoid any kind of injury such as heat conduction, material injuries, specific complications and specific follow-up. SUMMARY: The combination of safety and efficacy of endometrial ablation and hysteroscopic sterilization makes a compelling argument for their concomitant use.